Reoperation after pericardial patch tracheoplasty

Between 1982 and 1995, 28 infants underwent pericardial tracheoplasty for long-segment tracheal stenosis. Seven of these infants required reoperation or stenting for residual or recurrent tracheal or bronchial stenosis. Revisions were performed 2 to 6 months after the original procedure with cardiopulmonary bypass and bronchoscopic guidance. Two patients underwent repeat pericardial patch tracheoplasty, and four patients underwent insertion of a rib cartilage graft. Two of these patients required Palmaz wire expandable stents and one other patient also underwent stent placement. There was one late death 1 year after cartilage graft insertion. The authors identified three risk factors for reoperation after tracheoplasty; younger age at initial surgery and associated pulmonary artery sling or tracheal right upper lobe bronchus. Good intermediate results are possible in this difficult group of children using a selective and inclusive strategy for tracheal enlargement that includes repeat pericardial tracheoplasty, autologous cartilage grafts, and expandable wire stents.